Substance addiction is a perplexing phenomenon for those who fortunately do not suffer from it. Although it is incredible to believe that people would willfully engage in behaviors that create problems with their lives on so many levels, substance addiction is a reality for millions of people. According to data published by NIDA (National Institutes of Drug Abuse) nearly 20 million Americans have undergone opioid de-addiction therapy in 2010. What makes some people so susceptible to substance abuse while others are able to protect themselves? A study of brain images of heroin addicts, conducted by Gold, Liu and colleagues, shows significant differences in brain activity even in resting state, without heroin use. Functional MRI (fMRI) images from opioid addicted patients were compared with similar images from health people.

Resting state fMRI images of men undergoing opioid substitution therapy showed that areas of the brain engaged in reward perception, motivation, memory and self-control show significantly different activity than comparable regions in healthy individuals. Areas like the orbitofrontal cortex, cingulate gyrus and hippocampus show consistently different resting state activities in heroin-dependent and healthy subjects. The prefrontal cortex of dependent patients was less active than that of healthy patients in the resting state, during the course of de-addiction therapy. However, this area which controls motivation as well as degree of inhibition, was observed to be highly active during periods of opioid use. Other areas of the brain like the hippocampus which regulates memory, also showed activity patterns that were different from those in healthy subjects, in the resting state in addicted individuals. These images shed light on the mechanism of addiction in people and the areas of the brain that are engaged, perhaps constitutively, in sustaining addiction.

Given that study participants were enrolled from de-addiction clinics, episodes of heroin abuse had already taken place in their life. It is unclear whether the same areas of the brain would show similar activity in naive individuals. If this possibility is validated by comparative studies, these fMRI imaging techniques may have tremendous diagnostic potential in identifying people who are at high risk for addiction. One drawback of this investigation is that only male patients were included in this study. Therefore, we do not know whether there are gender-based differences in the resting state brain activity of female opioid addicts.

The study does throw up interesting possibilities. It is possible to enroll naive subjects, possibly teenagers or pre-teens, and obtain baseline brain images before these people have tried out any addictive substance like tobacco, heroin or alcohol. Follow-up studies with the same people can indicate whether experience of addictive substances can change the baseline pattern of activity. This kind of long-term and long-range study may help to identify brain markers for specific addiction disorders. The study also indicates why counseling fails to have an impact on some patients. It is likely that profound changes in resting state brain activity resulting from addiction may override the effects of received and processed advice.

The risk of SUD is often multi-factorial in its genesis & continuance; & includes an epi-genetic perspective. Part of what we are seeing in the neuro-imaging tools is, perhaps, the end result of neuromodulation between those who use & those who don’t.
And, we now have more deaths due to abuse of narcotic analgesics than we do w/ heroin. more young males are dying of NA’s than MVA’s! And in sad fact, 1 in 10 infants in the US show traces of opiates/opioids after birth!

And very sadly, NA’s are very easy to obtain from licensed practitioners.

The treatment of those w/ SUD is quite challenging & the stakes are quite high, including for those who love these folks.

Rich

Dr. Shefali Sabharanjak

Rich,
I fully agree with you.. Being a mom of a pre-teen kid, I am worried about these issues as well. My point is that we need to probably prevent ‘trial’ exposures to opioids in the form of grass and other recreational products as well. Science tells us that significant abuse of drugs can alter your brain circuits permanently perhaps rendering them intractable to higher-order thought processes. So, while some will still escape the habit after some initial trials, others may take an irreparable hit. At present, there is no way to distinguish between those at high risk of addiction and those who are at low risk. The only way to reduce and delay the age of exposure to even marijuana is to restrict access.

onergk69

Shefali,
Re: SUD vulnerability,

There is some research that suggests the significance of high novelty seeking, high reward dependence, high impulsivity, & low harm avoidance as known risk factors; and so are some of the following biopsychosocial factors:ability to highjack the brain in one dose, parental behvior about drugs, peer behavior about drugs, & cultural attitudes & behavior. Tho, the predictabilty is no where near 80% +.

Rich

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Diane Horton

I need some advice…I hurt my back real bad from the job I held for over 20 years doing Banquets, walking long distaces though the showrooms at different banquet facilities carrying 8-10 dinners/with metal covers across the showrooms to serve them their dinners. well Sice I suffer from terrible pain the dr has me on opioids. The dr has me at an amount that not even cancer patients dont even take.. dr has me at max 2-3 pills 5x’s a day. I loved what was written because its exactly what I have noticed from before starting on the 30 mg oxycodone pills. It has changed so many aspects of my life its unreal..I was in my early 30’s when Dr began to put me on this for my pain/adding to it up to the max amount so now where do I go from here. I am deadly afraid for my life, because this is such a big problem in the usa as I speak,,I want help so bad and havee for years, I tried to quit cold turkey for 5 streight days and I was in a disaster state, seemed as though I was worse as days went by. I have been looking around for some type of reseach to help me get off these things. It scares me so much . I am 47 now still on them, racking my brain on what am I going to do? this along with the 3 pills of 1 mg of xanax he also gave me a few years ago..1 mg. I heard that this point of getting off could actually kill me because of one the leagth of time on opiods/the amount, and the cost to do this properly with being watched by a dr on staff. the problem is that I am on permanate disability and after my bills are paid I dont have the $565.000 a day to go inpatient. I have a funny feeling I am not the only on out there that never in thir lifetime has done any street drug, or any drug for this matter. what does a person like me do being broke three cents left over after bills are paid/having no money the want to get into a proper inpatient tratment center for dependance. I want help so bad but I feel so trapped, so just cotinue taking this med day in day out..It has changed my life so much its unbelievable..I dont get high, it dos take my pain away which is good, but how I havee lost most o all my motervation to do anything, and yes I am sure it effected my brain funtion, as far as memory is not as good any mor, there is no where to turn unless I have $35,000-50,000 for help the right way. I often think would dr Phill help someone like me thats wants so badly to completly get off, but cant..this medician attaches to th receptors of the brain, which is very scarry, and where do people go to find help/ I have been looking for years and years, nothing!! in Las vegas where I live thy have a bed you l lye in for 2-3 days then they have to let you go because of the shortage of beds and to many patients/so my last hope is finding a reacherch of some sort that can help me..Im just disguted, and these dr’s when perscribed this md to me never sat and told me of thee long trm effects/addiction/dpendance nothing at all/just take this and it will take your pain away and it did..but now what Im getting older and I’m alone, and I am so scarred to dealth that I will eventually die from not having it unless I can get help..do you have any sugestions on what a neive person lik I was ( from a very tiny town of Douglas Ma had no idea what this was going to do to me like it has..I never run out, so the problem is not that..its my future that is..if I ever had to go to the hospital there is no way they are going to give me this amount so I will just withdraw in the hospital as they probably give me a single loratab…what do I do seriously can you help or now anyone that can help me get out of this? Please you have no idea what this means to me..I called a few dr’s to see if they would take payments for me to get help..no….they say cash/credit card..my credit is awsome, but I dont have 40,000 in my bal..I hope I am writing all this to the right place..any kind of responcee would be great..because of the usa abuse prcribed by these unregulated pill mills in florida has become such a shortage, which is another story..please help if you can…sincerly and serious…and a good woman who wants to get totally clean and live the life I had before I started taking this pills..heelp please help….this is no joke!! thanks so much Diane H

Dr. Shefali Sabharanjak

Dear Diane,
I feel sorry for what you have gone through. Perhaps your best option right now is to consult a doctor who will perform a complete and cohesive review of your health and prescribe some alternative medication or therapy for your back problem.
I am not familiar with the US healthcare and insurance system but you could check whether or not you stand to benefit from other medicine systems like Chinese medicine and Yoga. Believe me, I am not suggesting this out of blind faith. I just think that if the pain meds are creating other issues in your life, you should try out some therapy that is not dependent upon changing the chemistry of neurons in the brain and spine. Even with the alternatives, please do some background research into the practitioners of Chinese medicine and Yoga and make a judicious choice **before** you place yourself into their care.

You can also check out this hospital: http://iaimhealthcare.com/
This is a research centre and hospital in Bangalore, India where doctors are aware of Allopathic as well as Ayurvedic systems of medicine. The treatment modalities are Ayurvedic but the doctors are not fanatically against other knowledge systems.

I understand that this is a remote option, perhaps, but treatment is very inexpensive and if you write to the doctors there or chat over Skype you could probably work something out.

I cannot guarantee any resolution but I hope this helps.

Best,
Shefali.

Richard Kensinger, MSW

You are taking 2 potent CNS depressants which boosts one another, & neuromodulates brain endorphins. Xanax is very often used illicitly w/ Oxy 80’s; & it is a Schedule 2 controled agent. Never stop either abruptly. They need to be gradually tapered.

Since you are not a client of mine, I will not offer any clinical advise; otherwise I would be unethical.

I do wish you well,

Rich

http://www.westbridge.org/default.aspx long term addiction treatment

I recently found of that one of my best and closest friends has been using drugs. We lost touch with each other and our lives went if very different directions. I have been trying to get her into a long term addiction treatment center of some kind. Do you have any suggestions?

Shefali Sabharanjak, PhD, is a professional science and medical writer. She holds a doctorate in Cell Biology from the National Center for Biological Sciences. Clear and precise communication is her forte.

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